An Age-Based Analysis of Pediatric Melanoma: Staging, Surgery, and Mortality in the Surveillance, Epidemiology, and End Results Database

Abstract

The pediatric melanoma population is not well described, and current guidelines for their management are not well defined. Our study aims to identify this population, treatment modalities, and outcomes using a national population-based database. We reviewed the Surveillance, Epidemiology, and End Results database (2004–2008). Patients ≤21 years old with melanoma were included and grouped into ≤12 years of age, 13 to 18 years, and 19 to 21 years. Clinical characteristics were analyzed across the groups. A total of 1255 patients were included: 52.7 per cent were 19 to 21 years of age, 36.3 per cent were 13 to 18 years of age, and 11.0 per cent were ≤12 years of age. The 19- to 21-year-olds had the highest proportion of stage I (50.5%) versus ≤12 years of age (31.9%); the ≤12-year-olds had the highest proportion of stage IV (3.6%) versus 19 to 21 years of age (0.9%), P < 0.001. The 19- to 21-year-olds had the highest proportion receiving wide local excisions only (34.8%) versus ≤12 years of age (26.4%); the ≤12-year-olds had the highest proportion of patients without any surgeries (16.0%) versus 13 to 18 years of age (9.4%), P = 0.169. On adjusted analysis, the 19- to 21-year-olds had worse survival compared with ≤12 years of age (hazard ratio: 5.26, P = 0.017, 95% confidence interval 1.34–20.65). Disparities were found in the ≤12-year-old melanoma population, as they had later stage melanomas, less invasive surgery, and lower survival. Clearer prognostic factors are needed to better elucidate their management.

THE demographics and trends in pediatric melanoma in the United States: An analysis of the National Cancer Database

“…Similar trends have been observed in previous studies. 2,5,8,[12][13][14][15][16] However, our results differ from a previous international cancer registry analysis which found that males made up a greater percentage of cases before the age of 10, while females made up a greater percentage of cases after the age of 10. 8,13 Our results demonstrated a greater burden of melanoma in males age 13-15 and females age 16-17.…”

“…2,5,12,13,15,16 Other studies have also identified Hispanics as the group second most likely to develop pediatric melanoma after Whites. 4,15,16 By anatomic location, the most frequent presenting site was the trunk, while the least frequent site was the upper extremities and head/neck. Our findings are comparable to other studies which observed pediatric melanomas most often present on the trunk or lower extremities.…”

“…Similar to a previous SEER analysis, superficial spreading and nodular were the most common tumors while acral and lentigo maligna cases were rare. 12 Stratified by age, histologic subtype varied between children (0-12) and adolescents (13)(14)(15)(16)(17)(18). Superficial spreading (34.4%), nodular (16.3%), and epithelioid/spindle cell (16.3%)…”

Racial Differences in the Prognosis and Survival of Cutaneous Melanoma From 1990 to 2020 in North America: A Systematic Review and Meta-Analysis

“…Ultimately, 44 studies met our inclusion criteria and were included in this systematic review ( Supplemental Figure S1 ). 2 , 4 , 6 , 10 , 14 - 53…”

“…Five studies reported AJCC cancer stages for black patients, with weighted mean % of patients at stage I ( n = 501 patients, 52.6%) , stage II ( n = 223, 24.1%), stage III ( n = 123, 16.3%), and stage IV ( n = 101, 13.2%). 4 , 6 , 15 , 19 , 33 Seven studies comparing non-Hispanic white and black survival reported histological subtype stratified by race, with total patients and mean proportion of patients as follows: nodular melanoma (black: n = 1090, 10.0%; non-Hispanic white: n = 72029, 9.1%), lentigo maligna melanoma ( n = 196, 3.7%; n = 75631, 7.6%), superficial spreading melanoma ( n = 1611, 19.0%; n = 312754, 39.3%), and acral lentiginous melanoma ( n = 2107, 19.4%; n = 8141, 0.99%). 2 , 4 , 6 , 18 , 23 , 34 , 45 The most common subtype reported in black patients were superficial spreading melanoma in 4 studies, and acral lentiginous melanoma in 3 studies, while superficial spreading melanoma was the most commonly reported subtype for non-Hispanic white patients among all 7 studies.…”